Individual
JOHNATHAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3000 N HALSTED ST STE 803, CHICAGO, IL 60657-6185
(312) 376-1665
Mailing address
3000 N HALSTED ST STE 803, CHICAGO, IL 60657-6185
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
208001229
IL
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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